Is a well child visit covered when we switch doctors?
Usually yes, at 100% in network, because a checkup is preventive care no matter which office does it. Code 99382 is the first checkup at a new practice for a child aged 1 through 4. The new patient code pays the office more than the returning visit code, but the family owes the same thing, which is nothing.
100% covered
Preventive, no copay for the family
The 3 year rule
New patient means nobody of that specialty in the practice has seen the child in three years. Use it for a returning family and the claim gets downcoded.
365 day clock
Many plans count a full year from the last checkup, not from January. A toddler switching practices in the spring can trip that clock at the new office.
Two visits a year
Under age 3 the children's schedule calls for more than one checkup a year. Plans should follow it, but claim systems often cap it at one and deny the second.
Records lag
The old practice claim will not show up in your chart, but the eligibility check confirms the plan is active and shows the copay and deductible before the family arrives.
What would a real check show for this patient's 99382?
Pick a sample plan and type your fee. This is the visibility a real-time check gives the desk for every actual patient, in under a second.
Eligibility readout · 99382
Sample- Coverage
- Active, preventive care paid in full
- Frequency
- One checkup per plan year, ages 1 to 4
- Patient share
- Type your fee to see it
Estimate from a sample plan. A real check reads the actual plan in under a second.
When 99382 is the right code
- The child is 1 through 4 years old
- No same specialty visit in the group for three years
- The visit is a full preventive checkup
- Growth, development and counseling are documented
- Ages 5 through 11 move to 99383
Documentation payers expect
Payers expect the note to show a full checkup: the history, the exam, growth and development plotted, shots reviewed, and what the doctor talked through with the parent. If a real problem is handled at the same visit, that work needs a note of its own.
Why a new patient checkup gets denied
What happens after the first checkup
The first visit at a new practice tends to trigger catch up work. Missing shots get scheduled, each one adding a product line and an administration line to the claim. A lead test, 83655, may go out to a lab that bills on its own. Daycare and preschool forms bill as 99080, which many plans do not pay. The next checkup falls under the returning code, 99392. Checking the plan before the first visit is how the desk sees all of that coming.
99382, quick answers
We just switched pediatricians. Do we pay for the first checkup?
Usually nothing, since preventive visits are covered in full in network. The catch is timing, because if the old office already billed a checkup this plan year, the new one can be denied.
Why is the new patient visit more expensive on the statement?
New patient codes pay the practice more because the first visit takes longer. When the plan covers preventive care in full, the family share is still zero.
Can we have a checkup twice in one year?
Under age 3 the schedule calls for several, and Medicaid follows it. Whether a commercial plan pays each one is the part to check first, because some count a strict one per year at every age.
Does Medicare cover 99382?
No. Medicare does not pay this family of preventive checkup codes at all and uses its own wellness visit codes instead. It almost never comes up in pediatrics, since children are on commercial coverage, Medicaid or a parent plan.
What should we bring to the first visit?
The insurance card, the shot record and the date of the last checkup. That last one is what tells the desk whether the plan clock has reset.
More questions? Schedule 15 minutes with us and bring your toughest plan.
Every new family checked before the first checkup.
First month free, then $2.50 a check. No seat fees, no contract.
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Related: 99392 · 99383 · 99203
CPT is a registered trademark of the American Medical Association. This page is Valian's own plain-English summary for front-desk teams, not official CPT descriptor text, and is not billing or clinical advice. Coverage patterns are common plan behaviors; every plan differs. Verify benefits before the visit.